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Sites With Small Impedance Decrease During Catheter Ablation for Atrial Fibrillation Are Associated With Recovery of Pulmonary Vein Conduction
Author(s) -
CHINITZ JASON S.,
KAPUR SUNIL,
BARBHAIYA CHIRAG,
KUMAR SAURABH,
JOHN ROY,
EPSTEIN LAURENCE M.,
TEDROW USHA,
STEVENSON WILLIAM G.,
MICHAUD GREGORY F.
Publication year - 2016
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13095
Subject(s) - ablation , medicine , pulmonary vein , atrial fibrillation , catheter ablation , thermal conduction , cardiology , ohm , nuclear medicine , materials science , electrical engineering , composite material , engineering
Impedance Decrease During AF Ablation Objective To correlate impedance decrease during atrial fibrillation (AF) ablation with lesion durability and PV conduction recovery demonstrated during redo procedures. Background Markers of successful ablation beyond acute conduction block are needed to improve durability of pulmonary vein (PV) isolation (PVI). Local impedance decrease resulting from ablation is a real‐time marker of tissue heating and is correlated with lesion creation. Methods Impedance changes associated with point‐by‐point radiofrequency ablation in the PV antra were recorded during 167 consecutive first‐time AF ablations. During clinically indicated redo procedures, sites of recovered PV conduction were identified, and were correlated with the impedance change achieved during ablation at these locations during the initial procedure. Results Redo procedures were performed in 28 patients, in whom 19 sites of recovered PV conduction were documented. Most sites of PV reconnection (58%) occurred along the posterior PV antra. Ablation resulting in impedance decrease <10 ohms during the initial procedure was present in 89% (17/19) of sites with conduction recovery. Regions with adjacent ablation resulting in impedance decrease <10 ohms were associated with a higher rate of conduction recovery (37% vs. 1.5%, P < 0.001). Likewise, patients with PV conduction recovery demonstrated during redo procedure (Group 1) had larger regions where ablation resulted in <10 ohm impedance decrease than patients without PV conduction recovery (Group 2) (21.9 ± 15.5 mm vs. 11.5 ± 2.1 mm, P < 0.01). Conclusion Recovered PV conduction occurs predominantly in regions where adjacent ablation applications result in impedance decreases <10 ohms. Impedance‐guided ablation strategies may improve durability of PVI.